Age-related macular degeneration (AMD) continues to be the leading cause of central vision loss in the US today for those over fifty years of age and will likely become epidemic as Baby Boomers reach retirement age. Over the last 15 years treatments have become available to treat advanced AMD (1) but effectiveness of these advances is challenged by patients' lack of ability to recognize the need for urgent care between regular office visits. The Amsler and Yanuzzi tests, the only widely used self-tests for AMD, have proven largely ineffective at enabling patients to recognize the signs that they should consult their retina specialist for treatment. For optimal benefit, patients should be able to observe changes in their vision over time. The principal shortcomings of the Amsler grid include periodicity of the test pattern and lack of individual adjustment. For the current study, we have developed several versions of improved grids, both on paper and on the Internet. These patent-pending Visual and Mental Stimulation (VMS) grids are hypothesized to facilitate a substantial degree of recall of prior measurements, necessary for monitoring vision over time. Adjustment features have also been incorporated to allow patients to customize their grid to their particular visual field. In preliminary studies, positive feedback was obtained on initial prototypes from AMD patients and retina specialists. The result will lead to more rapid identification of problems, earlier diagnosis and treatment that will result in fewer people losing their vision. This project will pursue three areas of study: 1 Preparation of paper & electronic prototypes suitable for testing We will continue development of prototypes towards a reliable test tool, formalizing static testing elements and developing dynamic adjustment tools supported by a web-based work-flow logic approach and database. 2 - Comparative study of novel solutions with current prevailing test At the Wilmer Eye Institute of Johns Hopkins University, we will recruit 25 patients (Group 1) with recent onset of unilateral AMD under current care of a retina specialist. The study will compare the results of the novel self-diagnostic VMS tools with current self-monitoring tools (specifically the Amsler grid) over a 6 week period. Current clinical tools (FA, OCT & ICG) will be used to determine a reference baseline. 3 Study to gain feedback of patients' use of tests outside a clinical environment We will recruit two cohorts of 50 patients with recent onset of unilateral AMD under current care of a retina specialist (Group 2, Connecticut cohort) or at risk of AMD (Group 3, Baltimore cohort), and measure their ability to access and utilize the VMS tools without 3rd party support. Patients' success in using the system and their confidence level in results will be ascertained through a questionnaire. PUBLIC HEALTH RELEVANCE: Age-related macular degeneration (AMD) is the major cause of irreversible legal blindness in the western world. Current self-monitoring tools in patients with AMD fail to adequately indicate pathological vision changes that require immediate attention thus resulting in delayed treatment starts and higher incidences of severe vision loss. Through the application of a novel Visual and Memory Stimulating tool (VMS) this project will improve patients' ability to accurately and confidently self-monitor their AMD between office visits resulting in fewer people losing their vision. [unreadable] [unreadable] [unreadable]